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Sa2069 Efficacy of Percutaneous Endoscopic Gastrostomy Tube Feedings in Patients With Cystic Fibrosis
Abstracts
Children aged 2-18 years old, who had undergone elective colonoscopy within the last six months, and their parents, were recruited from the McMaster University Medical Centre Gastroenterology Clinic. Semi-structured interviews were conducted using an interview guide, with questions assessing the information provided, the understanding of the preparation protocol, and the compliance/tolerability of the preparation. Interviews were audiotaped, transcribed, and coded using a constant comparative method. Microsoft Excel was used to manage the data. Sample size was established when no new themes emerged. Results: 14 parents and 7 children were interviewed; fifty percent of the children were above the age of eleven. Emerging themes focused on participants’ need for information, particularly clarification of details regarding mixing the medication, NPO status, and clear fluid instructions. Barriers to successful bowel preparation included: lack of clarity on expected stool end goals, and pharmacists’ lack of familiarity with pediatric bowel preparations. Facilitators to a successful bowel preparation included: parental motivation for good preparation, ability to contact the gastroenterology team, and having few side effects of the medication. Conclusions: This is the first qualitative study identifying the challenges children face when undergoing bowel preparation for a colonoscopy. Individuals focused most on their informational needs. Identifying the barriers and facilitators to this process will assist in the development of tools to improve the experience and quality of bowel preparation for future patients.
Sa2069 Efficacy of Percutaneous Endoscopic Gastrostomy Tube Feedings in Patients With Cystic Fibrosis Racha T. Khalaf*2, Magdalen Gondor3, Vanessa Carr4, Denise Martinez5, Ernest Amankwah5, Michael Wilsey1 1 GI, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 2 Medical Education, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 3Pulmonology, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 4Nutrition, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 5CTRO, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL Background: Cystic fibrosis (CF) is the most common genetic disease in Caucasians. In a recent consensus statement, the Cystic Fibrosis Foundation emphasized that adequate nutrition is a vital element in preserving lung function and survival in patients with CF. Improving the nutritional status of patients with cystic fibrosis (CF) has been shown to have a positive effect on pulmonary function, respiratory status, and survival. Objective: Few studies have investigated the outcomes and efficacy of nutritional supplementation via percutaneous endoscopic gastrostomy (PEG) tube feedings in patients with CF. This study aims to assess the effect on nutritional status and lung function in patients with CF who are malnourished (BMI<50th %) and receive supplemental feeds via PEG tubes. Anthropometrics and lung function tests will be compared prior to and at one year follow up after PEG tube placement. Design/Methods: With IRB approval, we queried the electronic medical record at All Children’s Hospital Johns Hopkins Medicine. This retrospective chart review revealed 28 malnourished patients with CF aged 18 years and younger who received dietary supplementation via a PEG tube between 2010 and 2014. Results: Initial query of our census revealed 28 patients with cystic fibrosis who received supplementation with PEG tubes. Of these 57% were males and 96% were Caucasian with the remaining subject being multiracial. There was no observed significant change in FEV1 when compared prior to PEG tube placement and at one year follow up (pZ0.10). However, data obtained prior to PEG tube placement and one year post-operatively showed a significant rise in BMI percentiles (pZ0.009). Conclusions: Our data suggests that PEG placement for nutritional rehabilitation significantly improved BMI at one year follow up (p Z 0.009). FEV1 (p Z 0.10) showed no change. FEV1 may have been affected by confounding factors, including advanced lung disease. Longer follow-up may be needed to observe significant changes in lung function.
Sa2070 A Qualitative Analysis of Barriers and Facilitators to an Effective Bowel Preparation for Colonoscopy in Children Lara Hart*1, Humaira Nael2, Natasha Wickert2, Lawrence Mbuagbaw2, Mary Zachos1 1 Paediatric Gastroenterology, Hepatology and Nutrition, McMaster University, Hamilton, ON, Canada; 2Pediatrics, McMaster University, Hamilton, ON, Canada Introduction and objective: A well-visualized colon has a direct impact on the success of the colonoscopy, the interpretation of the findings, and the need for repeat procedure. Inadequate bowel preparation may be associated with missed diagnoses, procedure related complications, and increased resource allocations. Studies have been conducted in the adult population to assess factors contributing to improved bowel preparation for colonoscopy, however, no such studies have yet to be conducted in children. The primary aim of this study was to determine any barriers or facilitators to good bowel preparation with our current bowel preparation protocol. Methods: A qualitative interpretive description approach was utilized.
AB306 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Sa2071 Small Bowel Balloon Enteroscopy as a Treatment Modality for Retained Biliary Stents after Pediatric Orthotopic Liver Transplantation Gillian Noel*1,2, Shikha S. Sundaram1,2, Robert Kramer1,2 1 University of Colorado, Aurora, CO; 2Digestive Health Institute, Children’s Hospital Colorado, Aurora, CO Biliary complications after liver transplantation, including anastomotic biliary strictures and bile leaks, are common. Small-caliber plastic internal biliary stents may be placed in the biliary tree at the time of transplant across the anastomosis. These stents typically pass spontaneously into the gastrointestinal tract without complication during the first year post transplant. Retained stents, however, can cause complications such as biliary obstruction and cholangitis. Retained stents may be removed surgically or with percutaneous snaring by interventional radiology. We report four pediatric liver transplant recipients who underwent small bowel balloon enteroscopy for attempted removal of retained biliary stents. Methods: Four children with retained biliary stents, placed during orthotopic liver transplant, underwent small bowel balloon enteroscopy. Indications for transplant included hepatoblastoma (age 2y) and biliary atresia, status post portoenterostomy (ages 7m, 1y, 10y). With the exception of mildly elevated aminotransferases in one patient, all were asymptomatic prior to attempted stent removal. Attempted removal occurred at 8 months post initial placement in the symptomatic patient. In the asymptomatic patients, attempted removal occurred 16 months, 19 months, and 7 years after placement. At endoscopy, mean weight was 207kg. Using an Olympus SIF Q180 endoscope, single balloon small bowel enteroscopy was performed with fluoroscopic guidance, advancing until the entrance of the Roux loop was encountered and entered. For two patients, the stent was visualized at the level of the anastomosis and retrieved using a polyp snare without difficulty. In two patients, the stent was visible in the right upper quadrant on fluoroscopy but the entrance to the Roux loop was not identified and stents could not be removed endoscopically. One of these patients subsequently had the retained stent surgically removed. The other patient developed clinically apparent biliary obstruction from anastomotic stenosis, with the stent encased in granulation tissue. A drain was placed into the intrahepatic biliary tree and he underwent serial dilations of the stricture. The original stent was successfully removed by interventional radiology on the third attempt. Conclusions: Retained biliary stents are a known complication after pediatric orthotopic liver transplantation and can lead to biliary stenosis, cholangitis and obstruction. Stents can be removed in a less invasive manner using small bowel balloon enteroscopy if the entrance to the Roux limb can be identified endoscopically. Tattooing or other means to mark the Roux entrance at the time of surgery may be useful in the event of a retained stent. Further study will help identify optimal timing, ideal candidates, and potential complications of this treatment modality.
Sa2072 General Pediatricians and Management of Patients With GERD: Low Expectations for Endoscopy Ninfa Candela*1, Lloyd D. Fisher3, Gregory S. Germain2, Jenifer R. Lightdale1, Anthony F. Porto2 1 Pediatric Gastroenterology, UMass Memorial Medical Center, Worcester, MA; 2Pediatrics, Yale University School of Medicine, New Haven, CT; 3Pediatrics, Reliant Medical Group, Worcester, MA Background: Optimal management of gastroesophageal reflux disease (GERD) in children may involve treatment by general pediatricians, as well as referral to pediatric endoscopists. Despite guidelines that address indications for both, recent
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Children aged 2-18 years old, who had undergone elective colonoscopy within the last six months, and their parents, were recruited from the McMaster University Medical Centre Gastroenterology Clinic. Semi-structured interviews were conducted using an interview guide, with questions assessing the information provided, the understanding of the preparation protocol, and the compliance/tolerability of the preparation. Interviews were audiotaped, transcribed, and coded using a constant comparative method. Microsoft Excel was used to manage the data. Sample size was established when no new themes emerged. Results: 14 parents and 7 children were interviewed; fifty percent of the children were above the age of eleven. Emerging themes focused on participants’ need for information, particularly clarification of details regarding mixing the medication, NPO status, and clear fluid instructions. Barriers to successful bowel preparation included: lack of clarity on expected stool end goals, and pharmacists’ lack of familiarity with pediatric bowel preparations. Facilitators to a successful bowel preparation included: parental motivation for good preparation, ability to contact the gastroenterology team, and having few side effects of the medication. Conclusions: This is the first qualitative study identifying the challenges children face when undergoing bowel preparation for a colonoscopy. Individuals focused most on their informational needs. Identifying the barriers and facilitators to this process will assist in the development of tools to improve the experience and quality of bowel preparation for future patients.
Sa2069 Efficacy of Percutaneous Endoscopic Gastrostomy Tube Feedings in Patients With Cystic Fibrosis Racha T. Khalaf*2, Magdalen Gondor3, Vanessa Carr4, Denise Martinez5, Ernest Amankwah5, Michael Wilsey1 1 GI, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 2 Medical Education, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 3Pulmonology, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 4Nutrition, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL; 5CTRO, All Children’s Hospital Johns Hopkins Medicine, St Petersburg, FL Background: Cystic fibrosis (CF) is the most common genetic disease in Caucasians. In a recent consensus statement, the Cystic Fibrosis Foundation emphasized that adequate nutrition is a vital element in preserving lung function and survival in patients with CF. Improving the nutritional status of patients with cystic fibrosis (CF) has been shown to have a positive effect on pulmonary function, respiratory status, and survival. Objective: Few studies have investigated the outcomes and efficacy of nutritional supplementation via percutaneous endoscopic gastrostomy (PEG) tube feedings in patients with CF. This study aims to assess the effect on nutritional status and lung function in patients with CF who are malnourished (BMI<50th %) and receive supplemental feeds via PEG tubes. Anthropometrics and lung function tests will be compared prior to and at one year follow up after PEG tube placement. Design/Methods: With IRB approval, we queried the electronic medical record at All Children’s Hospital Johns Hopkins Medicine. This retrospective chart review revealed 28 malnourished patients with CF aged 18 years and younger who received dietary supplementation via a PEG tube between 2010 and 2014. Results: Initial query of our census revealed 28 patients with cystic fibrosis who received supplementation with PEG tubes. Of these 57% were males and 96% were Caucasian with the remaining subject being multiracial. There was no observed significant change in FEV1 when compared prior to PEG tube placement and at one year follow up (pZ0.10). However, data obtained prior to PEG tube placement and one year post-operatively showed a significant rise in BMI percentiles (pZ0.009). Conclusions: Our data suggests that PEG placement for nutritional rehabilitation significantly improved BMI at one year follow up (p Z 0.009). FEV1 (p Z 0.10) showed no change. FEV1 may have been affected by confounding factors, including advanced lung disease. Longer follow-up may be needed to observe significant changes in lung function.
Sa2070 A Qualitative Analysis of Barriers and Facilitators to an Effective Bowel Preparation for Colonoscopy in Children Lara Hart*1, Humaira Nael2, Natasha Wickert2, Lawrence Mbuagbaw2, Mary Zachos1 1 Paediatric Gastroenterology, Hepatology and Nutrition, McMaster University, Hamilton, ON, Canada; 2Pediatrics, McMaster University, Hamilton, ON, Canada Introduction and objective: A well-visualized colon has a direct impact on the success of the colonoscopy, the interpretation of the findings, and the need for repeat procedure. Inadequate bowel preparation may be associated with missed diagnoses, procedure related complications, and increased resource allocations. Studies have been conducted in the adult population to assess factors contributing to improved bowel preparation for colonoscopy, however, no such studies have yet to be conducted in children. The primary aim of this study was to determine any barriers or facilitators to good bowel preparation with our current bowel preparation protocol. Methods: A qualitative interpretive description approach was utilized.
AB306 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 5S : 2016
Sa2071 Small Bowel Balloon Enteroscopy as a Treatment Modality for Retained Biliary Stents after Pediatric Orthotopic Liver Transplantation Gillian Noel*1,2, Shikha S. Sundaram1,2, Robert Kramer1,2 1 University of Colorado, Aurora, CO; 2Digestive Health Institute, Children’s Hospital Colorado, Aurora, CO Biliary complications after liver transplantation, including anastomotic biliary strictures and bile leaks, are common. Small-caliber plastic internal biliary stents may be placed in the biliary tree at the time of transplant across the anastomosis. These stents typically pass spontaneously into the gastrointestinal tract without complication during the first year post transplant. Retained stents, however, can cause complications such as biliary obstruction and cholangitis. Retained stents may be removed surgically or with percutaneous snaring by interventional radiology. We report four pediatric liver transplant recipients who underwent small bowel balloon enteroscopy for attempted removal of retained biliary stents. Methods: Four children with retained biliary stents, placed during orthotopic liver transplant, underwent small bowel balloon enteroscopy. Indications for transplant included hepatoblastoma (age 2y) and biliary atresia, status post portoenterostomy (ages 7m, 1y, 10y). With the exception of mildly elevated aminotransferases in one patient, all were asymptomatic prior to attempted stent removal. Attempted removal occurred at 8 months post initial placement in the symptomatic patient. In the asymptomatic patients, attempted removal occurred 16 months, 19 months, and 7 years after placement. At endoscopy, mean weight was 207kg. Using an Olympus SIF Q180 endoscope, single balloon small bowel enteroscopy was performed with fluoroscopic guidance, advancing until the entrance of the Roux loop was encountered and entered. For two patients, the stent was visualized at the level of the anastomosis and retrieved using a polyp snare without difficulty. In two patients, the stent was visible in the right upper quadrant on fluoroscopy but the entrance to the Roux loop was not identified and stents could not be removed endoscopically. One of these patients subsequently had the retained stent surgically removed. The other patient developed clinically apparent biliary obstruction from anastomotic stenosis, with the stent encased in granulation tissue. A drain was placed into the intrahepatic biliary tree and he underwent serial dilations of the stricture. The original stent was successfully removed by interventional radiology on the third attempt. Conclusions: Retained biliary stents are a known complication after pediatric orthotopic liver transplantation and can lead to biliary stenosis, cholangitis and obstruction. Stents can be removed in a less invasive manner using small bowel balloon enteroscopy if the entrance to the Roux limb can be identified endoscopically. Tattooing or other means to mark the Roux entrance at the time of surgery may be useful in the event of a retained stent. Further study will help identify optimal timing, ideal candidates, and potential complications of this treatment modality.
Sa2072 General Pediatricians and Management of Patients With GERD: Low Expectations for Endoscopy Ninfa Candela*1, Lloyd D. Fisher3, Gregory S. Germain2, Jenifer R. Lightdale1, Anthony F. Porto2 1 Pediatric Gastroenterology, UMass Memorial Medical Center, Worcester, MA; 2Pediatrics, Yale University School of Medicine, New Haven, CT; 3Pediatrics, Reliant Medical Group, Worcester, MA Background: Optimal management of gastroesophageal reflux disease (GERD) in children may involve treatment by general pediatricians, as well as referral to pediatric endoscopists. Despite guidelines that address indications for both, recent
www.giejournal.org